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PERMIT APPLI�ATION <br />CITY OF EVERETT PERM17 SERVICES <br />3200 CEDAR STREET, EVERETT, WA �J8201 <br />425-257-8810 — FAX a25-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />21Q5 1/2 MCDOUGALL AVE #5 <br />LEGAL LOi N0. [iLOCK <br />DE3C. <br />PARCEL TAX I.D. N <br />00401544100300 <br />TRACT <br />_ � i <br />THOM/�S FL/�KE 71061/3MCDOVWLLAVEfl6.Evorol4Wn.Evoro11 98201 425-344-9546 <br />TENANT NAME I CONTACT FOR PERMR PHO!iE <br />Naida Khan/Northwest Permit Inc 360-945-2787 <br />CONTRACTOR IAIESCO A�URESS CITYTP PHONE <br />YV <br />CONTR. UCENSE= W�SHIES97106 2a00 Thorndyke Ave W Seatlle, ss�ss 2G'6-378-ti649 <br />USE OF BUIL�ING <br />Resid�ntial <br />HEATSOURGE <br />_ Electric X Gas,� Other <br />WORK oESCRIPTtON <br />Replacing a gas to gas 40 gallon water heater <br />NO. I TYPE OF FIXTURE OR ITEM <br />TOilet <br />� Balhtub <br />LOVOIOfy (W�3h 1789i�) <br />Shower <br />� Kitchen sink & disposal <br />Dishwasher <br />Glotfles waShAr <br />laundry tray <br />Sink (service/barlmop��tc.) <br />9achllow preventer <br />� Unnel <br />� Dnnking Fountain <br />Floordrain <br />� Gmase trap <br />Roof drains <br />Othvr <br />CONTRACT PRICE OF WORK <br />$950.00 <br />NO. I NPE OF FIXTURE OR ITEM <br />fVC — mr handling units <br />Foroetl air systems <br />Gas piping <br />Water heater <br />Gas freplace <br />Gas range <br />Clomes tlryer <br />Ranga hood <br />Exhaustfan <br />Heel NuiiiN <br />Unit heater <br />Boi�er <br />Rcfdgcration <br />Woodstove <br />Other <br />c1TY OF EVERETT LOC/U. SALE3 TAX CODE IS 9105 <br />i hereby conlify that 1 have read and examined this applia3tion and know the same to be trve and correct. All provisions of laws and <br />urd;nnces goveminy tbis lype uf wu�A �vill Le wmplicJ willi wheUim sprc.ifeJ I�eicin vr iwt. The granting of a pertnit does not presume <br />to give amhonty to vioiata or cancel ihe provision of any other state or local law regulating consVuqion or the pertormance of <br />constructian, Thal I am au)honzed by the owner olthis property to pedorm the woric torwhich app�ication is made and i cromply with the <br />Statc Conuactor� low 1'�'��W and 2062001NAC. <br />Pjj� / � r I <br />